Answers to all your questions about breast augmentation

Answers to all your questions about breast augmentation

When it comes to boobs, the grass often seems greener. Yes, I love my 32Ds, but sometimes I just want to wear a little crop top and not worry about my ladies bouncing around. Meanwhile, my less endowed friends are forever after the divide I can't seem to avoid.

Of course, there are surgical options for those who are not satisfied with their breasts. And for those looking to enhance their breasts, a breast augmentation may be just the thing you're looking for. To learn more about the procedure, including preparation, cost and downtime, we spoke with board-certified plastic surgeons Raj Mohan, MD, and Samuel Lin, MD. Keep reading to find out everything you need to know about breast augmentation.

Meet the expert

  • Raj MohanMD, is a certified plastic surgeon which specializes in cosmetic and reconstructive surgery of the face, breast and body. He is based in Dallas.
  • Samuel Lin, MD, is a board-certified plastic surgeon and associate professor of surgery at Harvard Medical School.

What is a breast augmentation?

Breast augmentation - colloquially known as a "boob job" and officially known as augmentation mammoplasty - is a surgical procedure using breast implants or fat transfer to increase the size, shape and/or symmetry of one's breasts. Implants are usually made of silicone or saline, while fat transfers use the patient's own fat, Mohan explains.

It is important to note that a breast augmentation cannot correct very sagging breasts, but a breast lift can. For those seeking breast augmentation with already sagging breasts, a facelift may be necessary in conjunction with an augmentation to ensure that the final results are more complete and lifted.

There is no "typical" breast augmentation patient, although Mohan and Lin note that candidates must be healthy enough to undergo elective surgery. Patients must be at least 18 years old to receive cosmetic breast augmentation. The FDA has approved the use of silicone implants for breast augmentation in patients 22 years and older, although Lin says they can be used off-label in some younger patients.

Benefits of breast augmentation

  • Increased fullness and projection of the breasts
  • More symmetrical breasts
  • Improvement of the balance of the breast and hip contours
  • Improvement of self-image and self-confidence

The main benefit of breast augmentation is, of course, improved breast appearance. Mohan and Lin say that this is often accompanied by increased confidence and quality of life for patients.

And it's not just about going up a cup size or two. While larger breasts are often the desired outcome for patients, this is not always the case. The American Society of Plastic Surgery reports that breast augmentation is one of the most effective procedures to correct noticeable breast asymmetry, and breast implants can be used to correct tuberous breast deformities.

Lin warns that any patient under peer pressure, spousal pressure, parental pressure or other pressure is not a good candidate for this procedure, nor are patients with body dysmorphia.

How to prepare for a breast augmentation

As tends to be the case with these types of procedures, the most important decision is finding the right doctor. It goes without saying that your plastic surgeon should be board certified and someone you trust. Look at lots of before and after photos to get an idea of a plastic surgeon's aesthetic style and see if it matches what you're looking for. You want to be able to clearly explain your goals to the surgeon and reference photos never hurt.

Both Lin and Mohan stress the importance of being well informed about all aspects of the surgery. Patients should consider the financial commitment and time required to undergo the procedure and recover, as well as any potential physical or emotional side effects.

When it comes to the procedure itself, patients have more choices than ever to customize a new look, from the type of filling to the shape, profile and size. If you opt for implants, no one type is generally considered the best. Options include saline, silicone and gummy implants.

  • Saline implants are filled with sterile salt water and tend to give the breast a uniform shape, feel and firmness. If an implant leaks, a saline implant would simply collapse, allowing the saline solution to be absorbed and naturally expelled by the body.
  • Silicone implants are made with silicone gel, which ultimately resembles natural breast tissue. Leaking silicone implants will not simply collapse. If the implants leak, the gel will either remain in the implant shell or leak into the breast implant pocket. Silicone implants are approved by the FDA for use in women 22 years of age or older.
  • Gummy bear implants are stable and retain their shape even if the implant shell is broken. The consistency of the gel inside gummy bear implants tends to be thicker and firmer than traditional implants. They also require a slightly longer incision in the skin.

There are some differences in cost, feel and incision requirements, so Lin recommends consulting with your surgeon to find the right implant for you.

Even after choosing an implant, there is still the shape and size to consider. Saline and silicone gel implants tend to be rounder, while gummy implants tend to come in a variety of shapes and rounded forms. Rounder implants help to achieve a fuller top of the breast, while shaped implants create a slanted look to the breast profile. As for size, implants range from about 150cc to 800cc. The size tends to depend on the size of the existing breasts, your personal goals and the recommendations of the plastic surgeon.

As surgery approaches, Lin suggests that patients identify a family member or support person to help them through the recovery process. An important note: Currently, there are no implants that last forever, so they will need to be replaced at the end of their natural lifespan. Mohan says that while manufacturers typically offer warranties of up to 10 years, there is a lot of fluctuation: "Some implants may last six to seven years while others may last 20 years," he explains. That said, a woman in her 30s can expect to replace her implants between two and five times in her lifetime (as implants become more durable with new discoveries, Mohan says that's a good rule of thumb for now).

What to expect during a breast augmentation

Breast augmentations are usually performed under general anesthesia, so patients should not expect much during the procedure. Mohan notes that while the length of the procedure differs from patient to patient, you can generally expect this type of surgery to last a few hours.

Once a patient is under anesthesia, it is time for the incision. There are a few techniques surgeons use to do this:

  • A submammary incision is made in the crease below the breast and leaves a thin scar of one to two inches. The advantages of this type of incision include a wider access point and easy scar concealment. Lin says this is the most commonly used type of incision.
  • A peri-areolar incision is made around the outer edge of the areola, in order to camouflage the scar in this natural pigment transition zone. This incision is usually used for patients who are undergoing a light to moderate breast lift at the same time.
  • A trans-axillary incision is made through the armpit, through which a surgeon places the breast implant using specialized instruments. Although this leaves a small scar in the armpit, it leaves the breasts completely unscarred.
  • A trans-umbilical incision is made just above the navel. The breast implants are then inserted through the incision and brought to the breast. Like a trans-axillary incision, a transumbilical incision leaves no scar on the breast itself (although there is a scar at the incision point). This approach is not usually possible with silicone implants and may void the warranty on saline implants, so be sure to ask your doctor.

Once the incision is made, the implants are then inserted either under the pectoral muscle or directly behind the breast tissue on the pectoral muscle. Placement depends on the type of implant, desired goals, the patient's body type and the surgeon's recommendations.

The incisions are closed layer sutures using sutures, skin adhesive and/or surgical tape to close the skin. And voila, a breast has been augmented.

Follow-up

Although the follow-up process is quite lengthy, Lin says most patients will go home the day of surgery. Once the anesthesia has worn off, patients are sent home with a medical compression bra over the incision bandages, which Mohan says helps minimize swelling and avoid tension on the stitches. It will be worn throughout the initial recovery process.

Of course, recovery varies depending on the location of the incision, the size of the implant and the location of the implant, although Mohan says many patients report chest tightness after the procedure regardless of the details. He also notes that patients may find that their breasts sit too high on the chest, but he says not to worry: the implants will fall out naturally as they settle.

Unfortunately, the first few days post-operatively are likely to be experienced with some discomfort and tenderness (as is the case with most surgeries). That said, Mohan says this should be more than manageable - in his experience, many patients don't need or even use their prescribed pain medication, and those that do usually use it for the first week or less.

While Mohan says patients typically return to work four to five days after surgery, he warns that implants placed under the muscle may require a full week of recovery. Non-impact activities can resume in about a week, and Lin says patients can resume light aerobic exercise within two to four weeks after surgery. Both doctors caution that any exercise involving impact should be suspended for at least a month.

Some upper body exercises can be resumed in about six weeks, as well as overhead lifting and wearing underwire and push-up bras.

Potential side effects

As with any surgical procedure, breast augmentations are not without risk. Potential side effects include scarring, bleeding, bruising, infection, dissatisfaction with the cosmetic result and change or loss of nipple sensation, Lin says.

What makes breast augmentation potentially riskier than other surgeries is the use of implants. Implant leaks and ruptures, implant-associated anaplastic large cell lymphoma, wrinkling of the skin over the implant, and implant malposition are all very real risks to consider. Another risk associated with the implant is capsular contracture. Normally, the body forms a capsule of scar tissue around the implant, but this capsule can sometimes distort the implant, causing problems that sometimes require more surgeries to resolve, according to Lin. Other side effects include the risk of general anesthesia, fluid accumulation, hematoma and persistent pain.

While there are several very real risks, breast augmentations are incredibly routine procedures. The risks are just that: risks, not certainties. According to Mohan, the surgery has been the most performed cosmetic surgery procedure since 2006, with more than 300,000 patients going under the knife each year.

The cost

Of course, the price of breast augmentation varies nationwide. That said, Mohan says a typical price range is between 5,000 $ and 10,000 $. This is roughly in line with 2020 data from the American Society of Plastic Surgeons, which reports that the average cost of a breast augmentation is between 4,516 $ and 6,000 $. This price does not include anesthesia, operating room facilities or any other related expenses.

The last takeaway

We can't - and won't - tell you if a breast augmentation is right for you. It's a big undertaking with a serious recovery time and a handful of potential risks. But if you're looking to improve breast size, shape and/or symmetry and are willing to pay for big results, a breast augmentation may be right for you.

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